The Evidence for a Population Screening Program for Rheumatic Heart Disease in India

Abstract

We read about the Himachal Pradesh Rheumatic Heart Disease (HP-RHD) registry data from Negi et al. [1] and would like to commend the authors for their efforts. Rheumatic heart disease (RHD) affects an estimated 15 million people worldwide [2], with between a quarter and one-half of all cases occurring in India [1]. We believe that there is a need for a population-wide intervention to reduce mortality and morbidity rates due to RHD in lowand middle-income countries such as India. Negi et al. [1] described the clinical characteristics and cardiovascular complications in, and management of, patients in India with RHD. This patient cohort had a particularly low uptake of prophylactic antibiotics and an underuse of valvular repair surgery was identified. The authors concluded that early detection of RHD is important for early identification of patients at high risk of adverse cardiovascular events. Of the patients who were enrolled in the HP-RHD registry, 15.7% had symptoms of advanced heart failure; and there was also moderate-to-severe valvular heart disease present in 69.3% of the cohort, indicating that RHD has a late presentation in this setting. Only 25.1% of patients recalled having acute rheumatic fever. This suggests that the best way forward is a population-based screening program, as three-quarters of patients could otherwise be missed.